细针穿刺细胞学(FNAC)与甲状腺超声检查在甲状腺结节治疗中的比较

Gunaratne Sa, Wijesinghe Hksn, Wijesinghe Cj, Disanayake Ske, Godak, age Mhp
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引用次数: 1

摘要

甲状腺结节是常见的,尤其是在女性中;尽管这些病变为恶性的可能性很小。在斯里兰卡,甲状腺癌是女性癌症的五大主要部位之一,男性和女性的终生风险均为0.357%。甲状腺病理诊断的金标准是组织病理学。然而,在初步调查中正确诊断治疗方案是很重要的。可用的诊断检查范围从生化、细胞学、影像学到组织病理学。其中,FNAC是评估甲状腺结节最准确、最具成本效益的方法之一,基因和免疫组织化学检测的结合进一步提高了FNAC的准确性[3,4]。近年来有研究报道FNAC的敏感性、特异性和准确性分别高达65-98%、72- 100%和95%。然而,英国皇家病理学家学会推荐FNAC在甲状腺肿瘤检测方面的敏感性、特异性和准确性的广泛值。在细胞学可疑、不充分和不确定的病例中,FNAC有一定的局限性,据报道,即使在足够的细胞标本中,4-15%的病例中也可能出现“不确定”的结果。因此,很难明确区分肿瘤和非肿瘤。此外,还有假阳性和假阴性。因此,结合使用另一项调查来弥补这些局限性。在一些研究中,甲状腺超声检查被认为是诊断甲状腺内病变最敏感的方法。据报道,USS的恶性特征包括明显的低回声,存在微钙化,不规则边缘,形状高于宽度的结节和彩色多普勒[8]的结节内血管充血。以上一种以上特征的出现,以及其中一些特征的结合,增加了甲状腺结节为恶性肿瘤的可能性。此外,它是非侵入性的,相对便宜,在斯里兰卡广泛使用。因此,有必要评估FNAC和USS在局部甲状腺病变诊断中的能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison on fine needle aspiration cytology (FNAC) and thyroid ultrasonography in management of thyroid nodules
A nodular thyroid gland is a common occurrence, especially among females; although chances of these lesions being malignant are rare [1]. In Sri Lanka, thyroid cancer is one of the five leading sites of cancer in females, and has a life time risk of 0.357% for both males and females [2]. The gold standard for diagnosis of thyroid pathologies is histopathology. However it is important to correctly diagnose during initial investigations for management plans. The available investigations for diagnosis range from biochemical, cytological and imaging to histopathology. Of these, FNAC is one of the most accurate and cost-effective methods of evaluating thyroid nodules, which is further improved by incorporation of genetic and immunohistochemical tests [3,4]. In recent studies sensitivity, specificity and accuracy of FNAC have been reported as high as 65-98%, 72-100, 95% respectively [3]. However The Royal College of Pathologists recommend a wide range of values for sensitivity, specificity and accuracy of FNAC with regard to detection of thyroid neoplasms [5]. Thy roid FNAC has some limitations in cases of suspi cious, inadequate, and indeterminate cytology and it is reported that, even in adequate cellular specimens, an “undetermined” result can occur in 4–15% of all cases [6]. Therefore, a definitive distinction between neoplasms and nonneoplasms is difficult. In addition, there are false-positives and false-negatives. Therefore, another investigation is used in combination to compensate for these lim itations. Ultrasonography (USS) of the thyroid gland is considered as the most sensitive method for diagnosis of intrathyroidlesions in some research [7]. The reported features of malignancy in USS include marked hypoechogenecity, presence of microcalcifications, irregular margins, nodule with shape taller than wide and intra-nodular hypervascularity in color Doppler [8]. The presence of more than one of the above features, and combination of some features, increase the probability that a thyroid nodule represents a malignancy [8]. In addition, it is non invasive, relatively inexpensive and widely available in Sri Lanka. Therefore it is necessary to assess the ability of FNAC and USS in diagnosis of thyroid pathologies in the local setting.
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